Confidence Goods 8
angry doc doesn't usually feature articles from The New Paper, but he would like to use this one as material for our exercise this weekend:
SCRAPPING OF MEDICAL FEE GUIDELINES
Health expert says: It won't work for specialist clinics
By Ng Wan Ching
April 05, 2007
APPLYING economic laws to healthcare products and services is tricky.
And consumer ignorance is one reason why market forces may not 'work to the full extent' when it comes to the cost of specialist care.
Health economist Phua Kai Hong, of the National University of Singapore, said this in response to the Singapore Medical Association's (SMA) statement that it will no longer issue guidelines on fees.
The association said the guidelines on fees may go against the Competition Act, which came into effect last January.
Recommending charges could be considered price-fixing and breaking the law.
On this issue, Associate Professor Phua, who was involved with the SMA in the past to revise the guidelines, said: 'The worry is not so much for primary healthcare. The GPs are already very competitive.
'With specialists, there is usually more consumer ignorance. This is where market forces cannot work to the full extent,' he said.
By the time patients need to see specialists, it may be an emergency or they are quite ill and may be psychologically affected. By then, few will seek a second or third opinion.
'(An unethical doctor) may decide to do a wallet biopsy to see how much the patient can afford. How many patients will know enough to make rational and cost-effective choices?' Assoc Prof Phua asked.
(Wallet biopsy is medical lingo to describe a check on a patient's financial ability to pay for medical services.)
Which is why he does not understand why the Competition Act should have any impact on the guidelines.
He said the guidelines were developed by comparing local fees here against the fee schedules of other developed countries as a fair and rational means of paying doctors.
'Healthcare is a special economic product. It has humanitarian and moral characteristics. It's very personal,' he said.
Assoc Prof Phua, who also chaired a past Health Ministry-related committee on Transparency in Hospital Billing in 2004, said there will be issues too if the doctor is not cost-conscious.
'He is in a position to order all sorts of tests and if the consumer is ignorant, it is very hard to challenge which tests are necessary and which are not,' he said.
He explained that the guidelines were there for reference on what was fair - a range of fees from the low end to the high end - but it was not something that had to be followed.
'In the US and almost all developed countries, that's how they do it. Every procedure has a fee guideline. Without it, there is no check and balance,' he said.
The problem, he added, is also compounded by the lack of comprehensive information on average bill sizes for private hospitals - they have given their bill sizes voluntarily and the list is not complete. Bill sizes also do not reflect doctors' fees, he pointed out.
A Health Ministry spokesman said that it is still working on getting more bill-size information from private hospitals for its website.
Associate Professor Goh Lee Gan, a past president of the SMA, said that individual doctors should now display their own GOF (guideline of fees).
'The patient can still ask the doctor what his fees will be, roughly. It's likely that life will go on as usual,' he said.
If a doctor overcharges, even if he is a specialist, word will get around and patients will leave.
He added: 'It is important to teach patients to find out what they are paying for and whether they get what they are paying for.'
For this, the press definitely has a role to play, Assoc Prof Goh said.
MOH said its guidelines under the Private Hospitals and Medical Clinics Act and Regulations still stand.
Before consultation, doctors are encouraged to inform patients on the likely charges. Every private hospital manager is required by law to ensure that every patient is informed, on or before his admission, of the estimated total charges for his hospitalisation and treatment.
This is to allow patient and family to make informed choices.
The Competition Commission of Singapore (CCS), which is the competition watchdog here, has welcomed the move by the SMA to remove its guidelines.
A CCS spokesman said this would permit greater flexibility for fees to be set by doctors in line with their business costs.
Such a move is more in line with today's circumstances.
Consumers would therefore benefit from the greater transparency and competition of prices.
Now count how many times the word 'quality' appears in the article.
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